Archives for January 2016

The first Global Health Rounds of 2016 took place on January 20th in the Sir Charles Tupper Medical Building. Global Health Rounds is a free public lecture series, focused on highlighting and discussing the global health activities at Dalhousie, as well as contemporary global health challenges, with leaders in the field. These sessions are offered monthly and anyone is welcome (and encouraged) to attend. Speaker and location details will be posted on the Global Health Office Website, Facebook, Twitter and Instagram.

January’s Rounds, led by Dr. Ingrid Waldron, was entitled “Race, Place & Waste: Exploring the Health Effects of Environmental Racism in African Nova Scotian & Mi’kmaw Communities.” Dr. Waldron discussed the Environmental Noxiousness, Racial Inequities and Community Health – or ENRICH – Project, which aims to better understand the effects of environmental racism in African Nova Scotian and Mi’kmaw communities, and to support their struggles against it. Dr. Waldron’s talk drew a crowd of more than forty students, faculty, health professionals and community members. We hope to see just as much enthusiasm for February Global Health Rounds: Health & Wellness of African Nova Scotians. Check out (and share) the Facebook event for more information, and to indicate your interest and plans to attend.

Some of the January Global Health Rounds attendees. We had to open a second room connected by video-conference because there were so many people!

What is Environmental Racism?

The first time I heard about environmental racism was in a 2013 article by Vice News about The Chemical Valley [1]. The Aamjiwnaang First Nations reserve near Sarnia, Ontario, home to about 850 Chippewa, sits surrounded by harmful chemical plants that produce gasoline and synthetic rubbers, among other materials. Why are these plants located next to a First Nations reserve, rather than in the midst of a middle class, primarily white neighbourhood? How do race and class shape where hazardous industries are located?

Dr. Waldron’s research in environmental racism seeks to answer these types of questions in Nova Scotia, while assessing the health impacts and working toward policy solutions. In Nova Scotia (and globally), there is a disparate location of hazardous industrial polluters in communities of colour, First Nations, in remote areas and among the working poor. The ENRICH project began with community consultations in the spring of 2012. Consultations took place in Yarmouth-Acadia First Nations, Eskasoni First Nation, Membertou First Nation, Lincolnville, and other affected communities. The concerns that were identified among these communities include (but are not limited to) fear of water and soil contamination, high rates of cancer, asthma and fetal anomalies and social nuisances such as loud noises, increased insects and mammals. Some women feel that their reproductive choices are limited, not wanting to expose a child to the aforementioned effects of environmental racism.

Dr. Waldron noted that environmental racism is an intersectional issue. Low income white communities also experience environmental racism, but their issues are often addressed more quickly. When there are multiple factors impacting the lack of power to be protected and heard (race, place and class) due to a history of forced displacement, social marginalization and destruction of culture and language, environmental racism worsens. Despite pushback from these communities who are affected by landfills and dangerous industries, there is a common response: in order to have grounds to remove them, there must be concrete, scientific proof that they are causing harm. The burden of this proof often falls on the communities, but it should be shifted to those responsible for environmental racism.

Bill 111

Communities experiencing the health and social impacts of environmental racism shouldn’t have to wait for 100% proof and validity to have their issues addressed. Dr. Waldron’s work, in collaboration with MLA Lenore Zann, culminated in presenting Bill 111, An Act to Address Environmental Racism, in the Nova Scotia Legislature.

In 2015, Bill 111 made it to second reading, but did not pass. Dr. Waldron is not discouraged, as the bill has introduced to the issue of environmental racism to many who were otherwise unaware. Bill 111 was featured in The Huffington Post, The Chronicle Herald, and is now on the record as being debated in the Nova Scotia Legislature [2]. She plans on introducing the bill again in the near future.

Future Directions

Dr. Waldron’s current work includes working with a dedicated team to develop an all-applicable Environmental Bill of Rights, stating that everyone has the right to clean air and clean water; the right to live, work, learn and play in healthy and sustainable places, among other standard rights that those impacted by environmental racism are not always afforded.

The Global Health Office would like to thank Dr. Waldron for her eye-opening talk about environmental racism, a pressing local and global health issue. To learn more about the ENRICH Project, you can visit their website [3].

On January 19th, the Global Health Office and student group, Health Association of African Canadians (HAAC-SO), presented a screening of the 2014 documentary Poverty Inc. by Michael Matheson Miller. The film was prefaced by a presentation on the social determinants of health by Lana M. MacLean, a social worker with the Dartmouth General Hospital Emergency Department.

What are the social determinants of health?

The social determinants of health, according to the World Health Organization, are:

The conditions in which people are born, grow, live, work and age. These circumstances are shaped by the distribution of money, power, and resources at global, national and local levels.

The social determinants of health perpetuate health inequities – unjust differences in health status that are avoidable. Health inequities are evident on a global scale, but they also exist in Canada, and even right here in Halifax. MacLean suggested that after the screening we read Social Determinants of Health: The Canadian Facts, a 2010 report by Mikkonen & Raphael that examines fourteen determinants such as gender, race, early childhood development and Aboriginal status, and how each impacts the health of Canadians. The report is available online for free, and I would also recommend taking the time to read and learn about the current state of health of Canadians [1].

Mikkonen & Raphael identify income as “perhaps the most important social determinant of health” [1]. Low income leads to material deprivation – an increased likelihood of being unable to access basic prerequisites of health such as food and housing. Low income can also lead to social exclusion, by creating barriers to participating in cultural, educational, and recreational activities, which in turn impacts well-being. MacLean used case studies from her own experience to prove that due to the social determinants of health “sometimes what works for one, doesn’t necessarily work for another.” I thought this quote tied in quite well with the message of Poverty Inc. – the paternalistic approach that is often used to combat poverty in low-income countries needs to be altered to fit the self-identified needs of those who have actually experienced these conditions.

Poverty Inc.

I attended the Poverty Inc. screening as a member of the Global Health Office team, an interested student, and as someone who has been heavily involved in (mostly local, but some international) charity work in the past.

The Poverty Inc. website provides the trailer, as well as the following synopsis:

The West has positioned itself as the protagonist of development, giving rise to a vast multi-billion dollar poverty industry – the business of doing good has never been better. Yet the results have been mixed, in some cases even catastrophic, and leaders in the developing world are growing increasingly vocal in calling for change. Drawing from over 200 interviews filmed in 20 countries, Poverty Inc. unearths an uncomfortable side of charity we can no longer ignore. From TOMs Shoes to international adoptions, from solar panels to U.S. agricultural subsidies, the film challenges each of us to ask the tough question: Could I be part of the problem? [2].

First of all, if you haven’t seen the film, you should. It will prompt you to reflect on the current aid, charity and social entrepreneurship systems, and how they often do more to hinder than to help those in resource-poor settings. The film opens with a poignant quote by Machiavelli:

The reason there will be no change is because the people who stand to lose from change have all the power. And the people who stand to gain from change have none of the power.

The film first examines how we have created a divide and an unbalanced power dynamic between rich and poor through our underlying assumptions of poverty, and the representations of lower income countries in the media. For a time, most of Africa was labeled as part of the “Third World;” as if this continent was on a lower tier than the rest of the earth. Take a moment to reflect on what you’ve seen and heard in the media with respect to charity and poverty – Do They Know It’s Christmas?, World Vision commercials, etc. – and think of how this impacts your views and beliefs.

They can tug at your heart strings, and can sometimes make you feel like people on the receiving end of donations are helpless and unempowered. We see this suffering, our immediate response is to give, and to encourage others to give. Poverty Inc. stresses that charity is almost always a product of caring people with good hearts. The documentary also supports the importance of humanitarian aid in emergency and disaster situations. But “when humanitarian aid becomes a way of life, we have a problem.” Using specific examples in Haiti and Kenya, and drawing on interviews with NGO employees and leaders, local business-people and scholars, Miller demonstrates how pouring free goods into an area for a prolonged period can effectively destroy local markets. The paternalistic power dynamic that has emerged from colonialism, and continues to persist today, means that charity and giving are often dictated by the desires and views of donors, not the self-identified needs of the recipients.

Poverty Inc. encourages film viewers to change the way they look at addressing poverty, moving from paternalism to partnership. They also highlight several NGOs that are getting it right, and how we can learn from their models. The take home message: think about how you are giving your money and time to charity, the best way to help people is to help them help themselves.

I hope I have piqued your interest in the film without giving too much away! On Dalhousie University’s Halifax campus, the film is available on loan from the Kellogg Library. For more information on GHO events, please visit our Website, Facebook, Twitter or Instagram.

Have you ever heard the saying “think global, act local?” This phrase was first used in the context of environmental challenges, however, it is becoming more and more relevant to the field of Global Health. Global health focuses on achieving health equity for all people, worldwide. Global health issues transcend national borders, and often impact those in our own communities. Therefore, we can begin to combat global issues by addressing them on a local scale.

The Dalhousie Global Health Office partners with a number of organizations in both Halifax and Saint John to provide a Local Global Health Elective program to first and second year medical students. The Local Global Health Elective is a half-year elective, which complements family medicine placements with community and social service organizations. This elective helps students develop a broad understanding of the health of socially marginalized groups in their own communities, and the services available to address their needs. The Dalhousie Global Health Office is also exploring building service learning opportunities to be launched in fall 2016. Stay tuned for more information about our exciting new Service Learning opportunities with UGME the coming months!

One of our newest partner organizations is the Dartmouth North Community Food Centre (CFC), a project of the Dartmouth Family Centre. The Dartmouth Family Centre is located in North Dartmouth, an under-served and high needs area: 13.5% of the population in this area is aged 65+, 31% of households are single-parents families, and 6.4% of the population are immigrants, a number that is expected to grow in coming years. The Dartmouth North CFC aims to increase the number of new entry points for families with young children, providing the community with a gathering space while expanding food access and skill-building opportunities. Community members come together to grow, cook, share and advocate for good food, through a variety of programs including a food distribution initiative, community kitchens and community gardens. You can learn more about how the Dartmouth North Family Centre combats local global health issues on their Website, Facebook or Twitter.

To learn more about our Local Global Health Elective opportunities, as well as our other offerings, check out our Website. As always, for information on our upcoming events, please check out our Facebook, Twitter or Instagram.

The deadline to apply for a 2016 summer Global Health Elective is February 5 at 4pm. These programs allow you to work on an interprofessional team with one of our international partner organizations, and to be mentored by a Dalhousie faculty member. These programs are available to students in Medicine (first & second year), Health Professions and Dentistry. We offer pre-departure training sessions for all students participating in international electives, and students complete in-country orientation. These elective opportunities (observerships) are available for the summer months in Tanzania, Ghana and Thailand.

Dalhousie student Braden Kingdon was a PASADA intern during the summer of 2015. In order to give you a better idea of what the PASADA internship entails, we asked him a few questions about his experience.

The program manager at the time contacted me personally through email about the opportunity. I am President of the Recreation Department Society at Dalhousie; she requested that I spread the word through our program. After spreading the word and thinking hard about it, I decided to apply myself as well.

2. What was your role as an intern at PASADA? What projects did you work on?

I was a part of a wide range of projects while at PASADA. I was initially sent out there with the intent of working with children who were living with HIV/AIDS, running health and safety clinics. This all changed upon my arrival in Dar es Salaam. I was working with the children yes, but only on Tuesdays for half of the day. For most of the other days I was working in the Key Populations (KP) Department, we tested and treated people within the marginalized communities of men who have sex with men (MSM), female sex workers (FSW), and injection drug users (IDUs). The KP department team would travel out into the communities to meet people at their homes with a mobile clinic. While back from the community, in the office I was mainly doing research. I was helping the medical director at PASADA put his dissertation together for publication in the Tanzanian Journal of Health Research. While helping him, I was also developing a research proposal for PASADA to help gain some funding and further their understanding of the MSM community. This was done through focus groups, personal interviews, and questionnaires. The overarching goal was to keep pushing towards increases in access to healthcare for the MSM community in Tanzania.

I believe it was helpful in enriching my experience in Tanzania. The material covered in the training was great at outlining safety precautions and travelling tips. The cultural aspect was a brief overview of what I was to expect, but it did not prepare me for the vast difference in way of living. In my opinion, this portion of the experience must be gained from actual exposure to the culture; no book or story will truly prepare you for the greatness that is the Tanzanian culture.

4. What have you learned from your experience in Tanzania? Has this impacted your day to day in Halifax?

My experience in Tanzania has taught me about the importance of living in the moment. Growing up in Canada we are all driven on this straight path towards success, if you fall off it you are often considered a failure. My time in Tanzania opened my mind up to the journey as opposed to just the end goal. If I ever had a bad day, my colleagues would lift me up and make me realize that I can only change what I can control, everything else is not worth worrying about. This has definitely followed me back to Halifax. Without the stress of worrying about uncontrollable factors I am able to focus on the tasks at hand, while enjoying the journey through life.

5. Drawing on your experience partnering with PASADA through the Global Health Office, how would you define a successful partnership?

I would define a successful partnership as one that has continual open communication, trust, and a mutually beneficial outcome. This is definitely something I feel the Global Health Office and PASADA had throughout my internship. I was able to contact anyone from the Global Health Office while in Tanzania, and the team at PASADA was an exceptional group of hosts. From teaching me Kiswahili to taking me to the beach for a sunset, it was a successful partnership inside and outside the walls of the clinic.

6. What advice do you have for Dalhousie students who are interested in the PASADA internship program?

My first piece of advice would be definitely apply because it will be the best summer (or term) of your life! I would also advise them to leave any preconceptions in Canada, it is likely that everyday will be a surprise and different from the last. It is also important to conquer your fears while you are there. Especially if you are in my case and you are by yourself for a while. Leave your comfort zone and go outside, walk around the city, there is so much to do! I found great friends in the American Peace Corp group who is always in Tanzania, and travels through Dar es Salaam regularly. But, do not limit yourself to this group of people. The staff at PASADA is very friendly and love to have fun, go to the movies with them, go to the beach with them, all you have to do is ask.

Local fish and chips on the beach (Photo: Braden Kingdon).

Thank you to Braden for taking time out of his busy schedule to share his PASADA experience with all of us! Braden has also kindly offered to answer any further questions you may have about the internship and his experience via e-mail.

Interested in International Electives? You can find more information on our offerings, as well as apply online, on our website. Remember – the deadline to apply is February 5 at 4pm!

Have you been, or are you planning to be involved in global health experiences throughout your university degree at Dalhousie? The Global Health Office wants to help enrich these learning experiences for you, while also providing you with formal recognition for your efforts.

The Advocates in Global Health Certificate is the first of its kind – helping you link all of your global health experiences. Over the course of this program, you will develop a holistic understanding of issues related to global health through mentorship, education, skills development and public engagement.

The certificate program has three overarching objectives:

To provide students with an educational framework to develop a robust understanding of global health. Students will become familiar with the major forces affecting the health of populations transnationally and understand the complexity of global health issues in diverse contexts.

To foster skill development in advocacy, a stated competency across the health professions.

The program requirements are flexible, and are usually completed over a two year period. The certificate requirements include knowledge, professional development, public engagement and global health competencies components. Options for fulfilling these requirements include (among others) attending Global Health Rounds sessions, completing a Global Health Elective class, undertaking an approved placement in a local low-resource setting, and serving on a Dalhousie Global Health Committee.

Upon completion of the program requirements, students will received a letter of achievement from the Global Health Office as well as the Advocates in Global Health Program certificate. This program is also recognized by Dalhousie’s Co-Curricular Record.

The certificate program is typically open to Dalhousie Medical School and Health Professions students; however, if you are in another academic program you may still be eligible. Please contact the Global Health Office if you have any questions about the certificate program.

There are a total of nine interprofessional mini-courses being offered throughout the 2015-2016 academic year here at Dalhousie University, which you can read about here. An interprofessional mini-course is a short, self-contained module that is offered to supplement interprofessional education experiences provided by individual programs. These courses require students from different professions to work together on projects, cases or issues, in order to allow participants to learn actively with, and from one another.

The Director of the Global Health Office, Shawna O’Hearn, will be teaching an interprofessional mini-course entitled “Global Health Through an Ethical Lens” this winter. The course will be delivered in the CHEB building on the corner of University Ave. and Summer St, with dates TBD.

Global Health is an inherently interprofessional field. Doctors, nurses, allied health professionals work together providing humanitarian assistance in refugee camps, performing surgery, consulting in remote village clinics and running immunization campaigns. These and other interprofessional settings will be explored through case studies. Complex health issues that transcend national borders are best addressed and solved using a multidisciplinary approach.

By the end of this mini-course, students will be expected to have:

an understanding of Global Health, in the local and international context;

explored global health ethics as part of an interprofessional team;

developed an ethical framework for the use of social media and photography to be used as part of knowledge translation and community education;

familiarity with global health offerings at Dalhousie and as part of their interprofessional career path.

In order to register for this IPHE mini-course, send an e-mail to the IPHE Course Registrar (iphereg@dal.ca) from your Dalhousie e-mail address. Include the following in the body of the e-mail:

The mini-course number (Course A) and name (Global Health Through an Ethical Lens) in which you wish to register.

Your name,banner number and NetID.

Your School and Faculty name.

Confirmation that you have not registered in another mini-course in the same term.

Map showing the 36 communities in Canada where there are existing Resettlement Assistance Program service provider organizations. (Source: Citizenship and Immigration Canada, December 29, 2015).

In 2013, 24,049 refugees made Canada their home through government assistance (GARs), private sponsorship (PSRs) and asylum-seeking [1]. A refugee is someone who been forced to flee their home country due to circumstances such as persecution, war or violence [2]. Worldwide, 60 million people have been displaced from their homes, and over half are children. In 2014, 53% of refugees worldwide came from just three countries: Somalia, Afghanistan, and Syria [3].

Since the outbreak of civil war in Syria began in 2011, millions have been displaced from their homes. Presently, 4.3 million Syrians are refugees, and 6.6 million more are displaced within Syria. Most of these refugees remain in Middle Eastern countries such as Turkey, Lebanon, Jordan and Iraq [4]. The Syrian Refugee Crisis prompted the Liberal government to make a pledge: to welcome 25,000 Syrian refugees as permanent Canadian residents before the end of December 2015. This deadline has since been pushed to February 29, 2016. Canada is partnering with the United Nations Refugee Agency to identify Syrian refugees in Jordan and Lebanon who are interested in coming to Canada. Security and health screening processes include an interview with visa officers, identity and document verification (both before and upon arrival), and health screening [5].

A total of 6,300 Syrian refugees have arrived in Canada since November 4, 2015, and another 5,307 refugee applications have been finalized. These figures are based on data from January 3, 2016. 85 communities across Canada (not including Quebec – their refugee program is run in-province) are currently preparing to welcome privately-sponsored Syrian refugees [6].

Once refugees arrive, they will be provided with immediate, essential services and long-term settlement support to ease their transition and integration into Canadian society. Support for GARs is provided by the Government of Canada, covering items such as clothing, food, temporary shelter and basic household needs. Social supports include assistance with finding permanent housing, employment and community orientation. Support seeks to align with provincial and territorial social assistance rates. Refugees resettling in Quebec receive similar support, but this is provided by the province. PSRs are provided with care, lodging, settlement assistance and social support by sponsors, who normally commit to 12 months of support, or until the refugee becomes self-sufficient (whichever comes first) [5].

Here in Nova Scotia, community donations have also been welcomed. On the first day of the Bayers Lake drop-off centre in Halifax, 1,500 bags of clothing, 200 pieces of furniture, 40 baby strollers and many children’s toys, toiletries and linens were donated. The centre is located at the former Rona location in the Bayers Lake Business Park, if you are in the Halifax area and interested in making an item donation such as winter outerwear, new toiletries, baby supplies, toys, school supplies and gift cards for groceries [7]. Many communities, both large and small, have begun refugee sponsorship and support groups. The Immigrant Services Association of Nova Scotia (ISANS) estimates that 500-700 Syrian refugees could be arriving in Nova Scotia in the coming months, though no concrete figures have been provided [8]. The ISANS website has a compilation of wonderfully laid out information about welcoming Syrian refugees in Nova Scotia, and what you can do to help, if you have further interest [9].

Many false claims have caused some in Canada (and in other countries) to be wary of accepting Syrian refugees. Thankfully, people worldwide have taken to the internet to debunk some of the myths around refugees, notably in the United States [10], the UK [11] and in Canada [12]. Additionally, ISANS has compiled a list of debunked myths for Nova Scotians [13] . We hope that you will take the time to read them if you are feeling skeptical, and to recognize that soon enough, at least 25,000 Syrian refugees, as well as other refugees worldwide, will be permanent residents of Canada. We should be treating them as such, by welcoming them into our diverse, nurturing, prosperous and peaceful country, with arms open wide.

The Canadian Council for Refugees applauds the warmth and hospitality provided by countless Canadians; however, they identify several key challenges that must be tackled in 2016 to ensure Canada’s refugee response is effective. Firstly, continuing support to Syrian refugees, while expanding immediate concern to refugees from all regions. This includes shortening processing times for resettled refugees from all countries, which has been shown to be possible through the recent effort with Syrian refugees. The Council also encourages Canadians to not stop their efforts at 25,000, specifically encouraging the government to support 25,000 refugees, with PSRs going over and above this number. Finally, equitable treatment for refugees, such as full coverage under the Interim Federal Health Program, is recommended [14].